The aim of the study was to assess the rate, pattern, and time of recurrence in patients with triple-negative breast cancer (TNBC) and to evaluate factors influencing recurrence and overall survival in this group of patients. Out of 2,534 consecutive breast cancer patients diagnosed between January 2005 and December 2006, 228 (9 %) were TNBC (ER/PR/HER2-negative). The clinicopathological characteristics were determined using descriptive statistics. The overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan–Meier method. The univariate and multivariate analyses were developed to identify factors influencing recurrence and survival in TNBC patients. After 6 years of observation, metastatic disease occurred in 35 % of all TNBC patients: 15 % in the brain, 14 % in the lungs, 11 % in the bones, 8 % in the liver, and 14 % had locoregional relapse. The highest risk of recurrence was during the first 3 years after primary treatment, and then, during the next 2 years of observation, it did not change. 6-year DFS and OS were 68 and 62 %, respectively. Factors influencing recurrence were tumor size and systemic adjuvant chemotherapy, while factors influencing overall survival were tumor size, nodal status, adjuvant/neoadjuvant treatment, and metastases in the brain, liver, and bones. Characteristic pattern of recurrence in time was revealed. The tumor size was responsible for recurrence despite lack of involvement of lymph nodes. Aggressive adjuvant/neoadjuvant treatment ordered in all clinical stages of TNBC (including N0) was factor responsible for avoiding local and distant relapse and prolonging overall survival.

Thanks, Donna. I'm still in chemo, but I'm already fixated on recurrence risk.

One thing that I was thinking about yesterday. My tumor has a very high KI-67, like 70%. I wonder if that makes it more likely that any recurrence would happen sooner, since it's so fast growing. Do the rouge cancer cells that would cause mets lie dormant, or do they immediately start dividing?

I guess I only wonder because it would be comforting to feel like recurrence risk was peaking earlier than the usual 3 year mark, and I'd be "out of the woods" a little earlier. :)

I'll ask my onc the next time I see her, but maybe someone has thoughts on this.

This is just my personal opinion but I don't hold much relevance in the KI-67 number. Anything over 20% is considered high and most TNBC is high. I thought having a 48% KI-67 number my chance of recurrence would be lower. I ended up with a recurrence anyway. I've seen many women that have had very high KI-67 numbers never recur.

I have a question on this...what do they consider a large tumor? Lots of articles talk about tumor size being so important but never give an actual size. Some small tumors get more "attention" then larger ones. Some women get mastectomies for small dcis tumors. I don't understand what they base decisions on when they talk about size. Does anyone know?

If you look at the chart, the risk of metastasis/recurrence in the bones goes UP after 5/6 years, while all other metastases/recurrence sites level off to practically nothing in the patients they studied. That's interesting. I wonder what that means?? Could this include blood cancers also (like what happened to Robin Roberts)?

Joni - I think anything under 2cm is considered stage 1 - at least that is what my oncologist had said.

This randomized phase II trial studies the effects of erismodegib (LDE225) on disseminated tumor cells (DTCs) in patients with stage III-III estrogen receptor (ER)-negative and human epidermal growth factor receptor 2 (HER2)-negative breast cancer. The presence of DTCs after completing treatment for breast cancer may be linked to recurrence of the disease. LDE225 may eliminate DTCs in bone marrow and reduce the risk of recurrence.

My breast oncologist at Washington University is working on this clinical trial: LDE225 in Treating Patients With Stage II-III Estrogen Receptor- and HER2-Negative Breast Cancer. I was not a candidate for trial because I had recurrence and one of prereqs is no recurrence incidents. From a lay person's understanding the way she explained it to me was like this:

1. This clinical trial thinks cancer cells might hide out in bone marrow that most non-lethal chemo regimens cannot kill because most chemo administered is not at the lethal levels that kills cells in the bone marrow itself (note: I'm not a doctor so don't hold me to this but I think if you get bone marrow &/or stem cell transplant they set out to kill all cells even cells in bone marrow and then they reseed your cells from scratch somehow in the bone marrow)

2. This trial will take a sample of your bone marrow to evaluate Disseminating Tumor Cell (DTC) presence, then treat you in such a way to train your immunity system to see the DTCs as some sort of allergy with the hope your immunity system will attack/rid your bone marrow of the DTCs. After x-months they take another sample of your bone marrow to evaluate DTC

Interesting but confusing I thought bone mets were more rare with tnbc it is more likely to spread to organs first.Should we have our doctors check this take a sample of our bone marrow? maybe I sound silly but rather be safe then sorry this was never mentioned to me ah another thing to worry about.Thank You,Denise

Some small tumors get more "attention" then larger ones. Some women get
mastectomies for small dcis tumors. I don't understand what they base
decisions on when they talk about size. Does anyone know?

Sizes (T1 to T4) and gradings (G1 to G4) matter.

My personal opinion: the point about "size" is that a huge tumor have (perhaps) larger hypoxic regions (regions with less oxigen/blood-supply). Hypoxia boost something called EMT (=loss of cell-cell-adhesion=>metastasis). Anyway - it seems just to be a statistical observation that huge tumors are a reason for

Grading is about differentiation.... something about EMT as well imho (EMT-> ephitelial to mesenchymal transition). Higher Gradings, lesser differentiated, more likely for spreading or/and agressiveness.

Triple-negative breast cancer: Recurrence and survival rates

A review from 2018, published in theBritish Journal of Cancer, analyzed data from people with triple-negative breast cancer. The results indicated that if someone survived for 5 years following treatment of the disease, there was a low probability of it recurring in the next 10 years.

Doctors believe that certain factors affect recurrence rates of triple-negative as well as other types of breast cancer.

Some factors that may increase the likelihood of recurrence include:

larger tumors

initial diagnosis when a person is 35 years old or younger

lumpectomy without radiation

involvement of the lymph nodes

According to specialists, the highest risk of recurrence typically occurs in the first few years following treatment. After 5 years, the risk of recurrence reduces.

People who have triple-negative breast cancer are also more likely to develop metastasis. Metastasis refers to a secondarycancerforming in a different part of the body.

One study, published in theJournal of Clinical Oncology, determined that metastasis was most likely to appear in the brain and lung. The researchers also concluded that survival rates are better when metastasis occurs in the bones.

According toBreastCancer.org, triple-negative breast cancer accounts for 10–20 percent of all breast cancers.

The organization also states that1 out of every 8women in the United States will develop invasive breast cancer at some point.

Doctors base survival rates on the percentage of people who are still alive at least 5 years after they received a diagnosis.

However, survival rates have some limitations:

Doctors base the rates on a 5-year time gap, so women who have received recent diagnoses may have a higher survival rate because of advancements in treatment.

They do not take recurrence, metastasis, or substages of cancer into account.

Individual factors, such as age and overall health, play a role in how long a person may survive.

Doctors calculate survival rates according to the stage of the cancer when the person received the diagnosis.

According toBreastCancer.Org, doctors typically class triple-negative breast cancer as grade 3. Anyone with this diagnosis should speak to the doctor about how their unique conditions affect the estimation of survival.

Good catch! Thanks for pointing the error out in the article. I edited the article to reflect what's on breastcancer.org's site. They meant to say Grade 3 (not Stage 3). Most TNBC is grade 3 when diagnosed.

"It tends to be higher grade than other types of breast cancer.
The higher the grade, the less the cancer cells resemble normal,
healthy breast cells in their appearance and growth patterns. On a scale
of 1 to 3, triple-negative breast cancer often is grade 3."

Current Strategies for the Management of Locoregional Breast Cancer Recurrence

Abstract / Synopsis:

Advances
in the treatment of breast cancer have decreased the rate of isolated
locoregional recurrences (ILRRs) over time. Surgery, radiation therapy,
and systemic therapies are used to manage these failure events and their
associated poor prognosis. Operable ipsilateral breast tumor
recurrences (IBTRs) are treated by either salvage mastectomy or, in
select cases, repeat lumpectomy. Axillary nodal recurrences and
postmastectomy chest wall relapses are commonly amenable to surgical
resection, too. Repeat sentinel node mapping may be undertaken after
IBTRs and chest wall recurrences. Aberrant lymphatic drainage,
especially after previous mastectomy, is frequently observed. Adjuvant
radiation is recommended for most ILRR cases; the dose and volume must
be adjusted for prior to receipt of therapy. Implementation of adjuvant
systemic therapies after ILRR should be based on the expression of
molecular markers in the recurrent tumor.
Administration of chemotherapy for estrogen receptor–negative ILRR is
indicated, since it significantly decreases the rate of distant
metastases.

Introduction

Much of the available data on the long-term risks of isolated
locoregional recurrences (ILRRs) in breast cancer are derived from
studies carried out in the 1980s and 1990s, when first-line primary
interventions consisted of modified radical mastectomy or lumpectomy and
axillary node dissection followed by whole-breast radiation
therapy.[1-6] Significant advances have occurred since then, changing
the landscape in which an ILRR occurs. Implementation of sentinel lymph
node biopsy (SLNB), routine use of systemic therapies, and the adoption
of partial breast irradiation (PBI) after lumpectomy are foremost.
Additionally, downstaging with neoadjuvant chemohormonal regimens, in
combination with increasing use of postmastectomy radiation therapy
(PMRT) and regional nodal irradiation (RNI), have enhanced the
effectiveness of locoregional treatments, while limiting the use of more
extensive surgery.

I honestly don't know how the researchers can cope with trying to find trend lines. Back in 2005 Tneg was a pretty young determination and often was treated the same as the positive dx. It was hard to find any trials at all.

Then in the next 5 years trials became more commonplace and many discoveries were made that really helped raise the outcomes of women with Tneg, including helping with quality of life during treatments.

Each year more and more trials became available and more and better treatments arrived so I feel like a word of caution that those of us who survived from the early years didn't have the substantial boone of what's available now.

All I'm saying is that it takes a long time for stats to be generated and most likely anyone's chances of overall survival are greater and greater each year.

You cannot post new topics in this forumYou cannot reply to topics in this forumYou cannot delete your posts in this forumYou cannot edit your posts in this forumYou cannot create polls in this forumYou cannot vote in polls in this forum